Harmony for Youth- Student Registration
All students are requires to complete a "Pay it Forward" Contract and Anti-Bullying Pledge at the Centre.
All students have the right to a safe space, but all students have the responsibility to respects the Centre, volunteers, teachers, executive director, and board of director members
Email address *
Student Registration Form
Please ensure you have the students emergency contact information ready, and health card ready.
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Health Card # *
Your answer
Address *
Your answer
Home phone number *
Your answer
Does the student have any health concerns or comments?
Your answer
Emergency Contact Information
To ensure that your student is fully safe while in our care, please ensure that your contact information is up to date.
Name *
Your answer
Relationship *
Your answer
Phone Number *
Your answer
Parent/Guardian Email Address
Your answer
Home Address *
Your answer
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